5 research outputs found
A randomized trial comparing intensified CNOP vs. CHOP in patients with aggressive non-Hodgkin's lymphoma
The standard CHOP regimen may cure 30-40% of patients with advanced
aggressive non-Hodgkin’s lymphoma (ANHL). Mitoxantrone is an
anthracenedione, which is active in NHL and its toxicity profile may be
more favorable than doxorubicin with respect to alopecia, mucositis and
cardiotoxicity. This study was designed to compare the effectiveness of
an escalated dose of mitoxantrone with that of standard doxorubicin,
used in the CHOP regimen in patients with ANHL. One hundred and forty
three eligible patients with ANHL were randomized to receive 6 cycles of
either CHOP (n = 71) or intensified CNOP (iCNOP) (n = 72); with
mitoxantrone 20 mg/m(2), i.v., d.1 instead of doxorubicin. Complete
responders (CR) were again randomized either to receive interferon-alpha
(IFN-alpha) maintenance (3 MU t.i.w., s.c.) or not. The CR rate was 70
vs. 76% for iCNOP and CHOP (p = 0.45); and the overall response rate
was 81 vs. 83%, respectively (p = 0.71). The 5-year failure free
survival (FFS) was 48 and 50% in the iCNOP and CHOP arm, respectively
(p = 0.45), and the 5-year overall survival (OS) was 61 vs. 64% (p =
0.56). IFN-alpha did not prolong relapse free survival (p = 0.91), iCNOP
produced less alopecia (p = 0.001) but more febrile episodes (p = 0.04)
than CHOP, while requiring more frequent G-CSF support (p = 0.01). Two
cases of acute myelogenous leukemia (AML) were recorded, both in the
iCNOP arm (p = 0.14). In conclusion, iCNOP was equally effective to CHOP
in patients with ANHL, producing more leukopenia and febrile episodes,
but less alopecia. The development of two cases of secondary AML in the
iCNOP arm is of concern